Apparatus and method for esophageal cooling

ABSTRACT

A balloon catheter is used in a closed-loop heat exchange system for manipulating the temperature of a patient. The balloon catheter is positioned in the stomach of the patient, and then expanded with a heat exchange fluid delivered through a lumen formed in the shaft of the catheter. The balloon catheter comes into contact with the wall of the stomach, and the stomach substantially conforms around the expanded balloon catheter. The heat exchange fluid is allowed to flow continuously into and out of the balloon catheter. Heat is exchanged between the balloon catheter and the stomach so as to controllably alter the temperature of at least a portion of the patient. Anti-shivering mechanisms and automatic control based on temperature feedback from the patient may be used in connection with the heat exchange system.

This application is a continuation of U.S. application Ser. No.14/859,594, filed Sep. 21, 2015, which is a continuation of U.S.application Ser. No. 14/181,297, filed Feb. 14, 2014, now U.S. Pat. No.9,138,344, issued Jun. 18, 2013, which is a continuation of U.S.application Ser. No. 13/037,224, filed on Feb. 28, 2011, now U.S. Pat.No. 8,652,190, issued Feb. 18, 2014, which is a continuation of U.S.application Ser. No. 11/474,590, filed on Jun. 26, 2006, now U.S. Pat.No. 7,896,009, issued Mar. 1, 2011, which is a continuation of U.S.application Ser. No. 10/051,870, filed on Jan. 16, 2002, now U.S. Pat.No. 7,077,825, issued Jul. 18, 2006, the contents of which are herebyincorporated by reference in their entirety. Applicant claims priorityto all of the applications in the chain.

This invention relates generally to apparatus and methods for theselective modification and control of body temperature by lowering,maintaining or raising the temperature of a portion of a patient's body.More particularly, the invention relates to the application of a gastrictemperature control technique using a heat exchange fluid circulatedthrough a balloon catheter.

BACKGROUND OF THE INVENTION

Normothermia is a condition of normal body temperature. Thoughtemperature does vary at different parts of the body, the normal corebody temperature of a human adult is often stated to be at 98.6 degreesFahrenheit or 37.0 degrees centigrade. There are numerous therapeuticreasons for inducing hypothermia (a decrease in the core bodytemperature), or warming a hypothermic patient to normothermia, or(rarely) to hyperthermia, or inducing normothermia (approximately 37degrees centigrade) in a patient suffering from an elevated temperature.For example, hypothermia may be induced to minimize damage to the brainor spinal cord when a patient has suffered a head injury or stroke, orto minimize damage to heart and brain tissue when a patient hasundergone cardiac arrest or suffered a myocardial infarct (heartattack). Mild hypothermia has been shown to both increase thecontractility of the heart muscle and to reduce its metabolicrequirements. Indeed, if the hypothermia is systemic, the metabolicdemands of the entire body are generally reduced, so that the demandsplaced on the heart may be reduced. It may sometimes also be desirableto induce hypothermia during surgery, especially neurosurgery, onceagain to minimize tissue damage.

Cooling is well accepted as a neuroprotectant, and may be helpful for apatient suffering ischemic insult to the brain or spinal cord, such as astroke or trauma. It is also known that a fever significantly increasesthe risk of a bad neurologic outcome suffered by a stroke victim. It maytherefore be beneficial to cool a stroke victim who would otherwisedevelop a fever.

Temperature control over a patient may affect the activity of variousdrugs applied to a patient for therapeutic reasons, such aschemotherapeutic drugs. A physician may wish to control such patient'stemperature above or below normothermia. The temperature may also haveother therapeutic value, such as reduction of inflammation, ordestruction of certain infectious agents such as bacteria or viruses.

In re-warming a patient, either after therapeutic hypothermia or apatient suffering from accidental hypothermia, a very gradual andcontrolled re-warming rate is often desirable. The dramatic generationof metabolic heat due to shivering, particularly in addition to heatadded by other means, can result in rapid and uncontrolled re-warming. Atherapeutic regimen for controlling body temperature preferably does soat a carefully monitored and controlled rate.

Early techniques involved application of cold to the skin surface orcooling the inspired air, alone or in combination. However, the humanbody has very effective thermoregulatory responses such asareterio-venous shunts, vasoconstriction, and shivering, that generallycombine to make such surface cooling and cold breathing gasesineffective to control core body temperature. In situ blood temperaturemodification using a heat exchange catheter system was described in U.S.Pat. Nos. 5,486,208, 5,837,003 and 6,110,168, all to Ginsburg, thedisclosures of which are incorporated herein by reference in theirentireties.

A method to exchange heat between a device positioned in the esophagusand a proximately located thoracic vessel, such as the descending aorta,in order to increase or decrease the temperature of the blood flowing inthe vessel was described in U.S. Pat. No. 5,531,776 to Ward et al.,entitled “Non-Invasive Aortic Impingement and Core and CerebralTemperature Manipulation Method,” the contents of which are incorporatedherein by reference in their entirety. The device includes an esophagealballoon which can be enlarged to displace the wall of the esophagustoward the thoracic vessel. The esophageal balloon includes a heattransfer surface, and heat is exchanged between the heat transfersurface and the blood flowing through the vessel across the wall of theesophagus and the wall of the vessel. The inflation of the balloonwithin the esophagus, however, may block the esophagus with variousproblematic results, for example blockage of saliva drainage to thestomach, and may limit the duration of the temperature treatment.

Controlling body temperature through gastric lavage (which is sometimesreferred to as stomach pumping) involves the cyclic application of acooling fluid directly to the stomach. In gastric lavage, up to about500 ml of cooled sterile water is delivered into the stomach undergravity through an orogastric tube. Some of the water is lateraspirated. The direct application of fluid to the stomach, and aninability to aspirate much of the delivered water, may cause abdominalcramping, gastrointestinal irritation, and diarrhea. This method is alsogenerally messy and not suited for use in many environments, for examplehospitals or ambulances. This procedure may also be limited by theamount of fluid which may be delivered into the stomach, particularlywhere a patient is very sensitive to fluid overload such as a patientsuffering a myocardial infarct.

Therefore, there continues to be a need to develop a convenient methodof controlling body temperature, e.g., inducing hypothermia or otherwisereducing the body temperature, or gently and slowly raising the bodytemperature from a hypothermic state.

SUMMARY OF THE INVENTION

The stomach, especially when expanded, is a highly vascularized organ.As such, it provides an excellent location to add or remove heat fromthe bloodstream of a patient. A cooling catheter with a heat exchangeregion placed within the stomach can cool the blood flowing through thestomach which will then rapidly circulate throughout the body of apatient and thus rapidly affect the body temperature of the patient. Inaddition, the stomach is located in the core of the body, and any heatexchanged through conduction is directly exchanged with the core of thebody and therefore avoids many of the defenses the body has that havebeen developed to prevent heat exchange with the external environment.

Where a balloon catheter is positioned in the stomach of a patient, heatis exchanged between the balloon catheter and the stomach so as tocontrollably alter the temperature of the blood flowing through thestomach. The balloon catheter may be expanded to distend the stomach andto press against the stomach lining. The heat exchange system of theballoon catheter is capable of altering the temperature of a substantialportion of the patient's body, i.e., more than just the lining of thestomach. A heat exchange fluid may be circulated in a closed-loopfashion through the balloon catheter placed in the stomach for theselective modification and control of the body temperature of thepatient. By controlling the temperature of the heat exchange fluidcirculated through the balloon catheter, heat can be transferred to orfrom blood flowing in the stomach tissue, and the core body temperatureof the patient may thereby be increased or decreased.

The balloon catheter may comprise a balloon into which a heat exchangefluid is delivered through a first fluid lumen and from which the heatexchange fluid is circulated out of the balloon through a second fluidlumen. The balloon is expanded by the delivered heat exchange fluid suchthat heat is exchanged between the stomach and the heat exchange fluidcirculating in the balloon so as to controllably increase or decreasethe temperature of the blood flowing through the stomach. Where the heatexchange fluid is a cooling fluid, hypothermia may be induced in thepatient. The application of mild hypothermia may increase thecontractility of the heart muscle and reduce the metabolic requirementsof the heart. The present invention may also be used for the controlledre-warming of the patient.

In one embodiment of the invention, a temperature probe that senses thetemperature of the patient provides feedback by which the rate of heatexchange between the balloon catheter and the blood in the stomach maybe controlled. For example, to reduce the rate of cooling, thetemperature of the heat exchange fluid may be increased, or the rate ofcirculation may be reduced. This may be automatically achieved inresponse to the temperature signal from the probe.

It is also the case that the human patient may respond to cooling by thethermoregulatory response of shivering. The human shivering threshold isgenerally about 35.5° C., a temperature below which the patient beginsto shiver. In order to combat the body's natural tendency to generateadditional heat through shivering, anti-shivering agents may be used.The anti-shivering agents may include agents as simple as a warmingblanket, or may include various drugs. A method to combine cooling withanti-shivering agents is disclosed in U.S. Pat. No. 6,231,594 to Dae etal., the complete disclosure of which is incorporated herein byreference.

The heat exchange catheter system may further include an external heatexchange unit for heating or cooling the heat exchange medium. Thisexternal heat exchange unit may further comprise a pumping mechanism forcirculating the heat exchange fluid through the heat exchange catheter.The external heat exchange unit may also be controlled by a control unitthat may control the temperature to which the circulating heat exchangefluid is adjusted, the rate at which the heat exchange fluid iscirculated, or other parameters that may affect the rate of heatexchange between the catheter and the patient's bloodstream. Thecontroller may receive input from the temperature sensor mentionedabove, and may control the rate of heat exchange between the catheterand the patient's bloodstream in response to said input.

Various suitable controllers and external heat exchangers may be used.For example, the controller and heat exchanger as disclosed in U.S.patent application Ser. No. 09/138,830 to Machold et al.; Ser. No.09/563,946 to Machold et al.; and Ser. No. 09/707,257 to Machold et al.Another system for controlling the body temperature of a patient isdisclosed in patent application Ser. No. 09/938,851, entitled “Method ofInotropic Treatment of Circulatory Failure Using Hypothermia,” thecontents of which are hereby incorporated by reference in theirentirety.

Further aspects of the present invention will become apparent to thoseof skill in the art upon reading and understanding of the detaileddescription and examples set forth below.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a depiction of an embodiment of the balloon catheter in placein a patient with a heat exchange unit for practicing the invention.

FIG. 2 is a sectional side elevation view illustrating the chest cavityof a patient and showing an embodiment of the balloon catheter forpracticing the invention in an operative position.

FIG. 3 is a sectional view of a portion of an embodiment of the ballooncatheter for use in the invention.

FIG. 4 is a cross-sectional view of the catheter shaft through lines 4-4of FIG. 3.

FIG. 5 is a sectional view of a portion of an alternate embodiment ofthe balloon catheter for use in the invention.

FIG. 6 is a cross-sectional view of the catheter shaft through lines 6-6of FIG. 5.

FIG. 7 is a depiction of an embodiment of the balloon catheter and heatcontrol unit for use in the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

As shown in the exemplary drawings, the invention is directed toward anon-invasive gastric apparatus and method of cooling, or otherwisemanipulating, the body temperature of a patient using a ballooncatheter. As used herein, like reference numerals will designate similarelements in the various embodiments of the present invention to bediscussed. The invention will be described in relation to the use of aheat exchange fluid circulating within a balloon catheter placed withinthe stomach of a patient to induce hypothermia, or otherwise control thebody temperature of the patient. It is to be understood, however, thatthe invention is not so limited. For example, although the inventionwill be described as using a heat exchange fluid, it is to be understoodthat other heat exchange mechanisms can be used.

Hypothermia is preferably induced in a manner fast and efficient enoughto cool the patient without undue stress. Hypothermia may be induced byusing a catheter that circulates heat exchange fluid through a heatexchange region (e.g., a balloon), and circulating the heat exchangefluid through an external heat exchanger to adjust the temperature ofthe heat exchange fluid and then recirculating the heat exchange fluidthrough the heat exchange region of the balloon. This circulation iscontinuous, preferably in a closed circuit, exchanging heat from thesurrounding tissue into the heat exchange fluid, and then out of theheat exchange fluid in the external heat exchanger for a sufficientlength of time to cool the patient to achieve the desired advantages ofthis invention.

Inducing hypothermia has many advantages. For example, in a patientsuffering from circulatory failure, including congestive heart failure,inducing hypothermia increases the contractility of the cardiac musclecells, similar to an inotropic drug, while at the same time reducing themetabolic oxygen requirements of those same muscle cells. If thehypothermia delivered is systemic, the metabolic requirements and wasteproducts of the entire body are reduced, which reduces the overalldemands on the heart.

The general method of the invention may comprise using a gastric coolingdevice such as a cooling balloon catheter to: induce hypothermia in thepatient; maintain the patient in the hypothermic condition for asufficient time to provide a therapeutic benefit; and re-warm thepatient in a controlled manner. The same heat exchange system used toinduce the hypothermia may be used to re-warm the patient. Morespecifically, the patient may be cooled to a temperature between 32° C.and 36° C., maintained at that cooled temperature for a period of threehours, six hours, or even a day or more, and then re-warmed tonormothermia, generally 36.5° C. to 37° C. Generally the warming is slowand controlled, sometimes as slow as 0.2° C./hour.

The method may also be practiced with automatic control over the heatexchange mechanism that is inducing and maintaining hypothermia. Atemperature probe that senses the temperature of the patient provides asignal to an automatic controller that, in response to that signalrepresenting the measured temperature, controls the hypothermic state ofthe patient. The patient's temperature may be under the control of anautomatic temperature control system governed by a signal from atemperature probe in or on the patient's heart, esophagus, blood stream,tympanic membrane, skin, or other area that will deliver a signal thatis representative of the core temperature of the patient.

The method may additionally include the steps of: administering ananti-shivering agent; automatically controlling the patient'stemperature using feedback from a temperature probe on or in thepatient; and re-warming the patient, perhaps at a very slow andcontrolled rate. To prevent shivering, a warming blanket and variousanti-shivering drugs may be used either alone or in combination. Theanti-shivering regime is generally started before the patient is cooledbelow the shivering threshold.

As illustrated in FIG. 1, the balloon catheter 20 is introduced throughthe esophagus 12 and delivered into the stomach 10 of a patient with theballoon 22 deflated. The entire balloon 22 is located within the stomach10, and the catheter shaft 24 is located within the esophagus 12 of thepatient. The distal end of the catheter shaft 24 may further includeradiopaque markers adjacent to the proximal end of the balloon 22 toidentify when the balloon 22 is positioned fully within the stomach 10of the patient. A sheath (not shown) may be wrapped around the deflatedballoon at the distal end of the catheter shaft in order to assist inmaintaining a small delivery profile for the catheter. Such a sheath mayinclude perforations to allow the balloon to expand upon inflation byfluid delivered through the catheter shaft 24.

The shaft 24 of the balloon catheter 20 may have a coaxial lumenconfiguration, a side-by-side (or dual) lumen configuration, or anyother suitable lumen configuration to allow the ingress and egress of aheat exchange fluid to and from the balloon 22. The heat exchange fluidis supplied through an inlet 26 and returned through an outlet 28 in aclosed-loop fashion. A heat exchange unit 30 circulates the heatexchange fluid to the balloon catheter 20 as part of a closed-loopsystem. The heat exchange unit 30 controls the temperature of the heatexchange fluid, and can maintain the heat exchange fluid at a constanttemperature for an extended period of time. The balloon catheter 20 mayfurther include a handle 32 to assist in positioning the ballooncatheter in the stomach 10 of the patient. The balloon catheter 20 maybe disposably attached to the heat exchange unit 30 at the handle 32.

As illustrated in FIG. 2, after introduction of the balloon catheter 20into the stomach 10 of the patient, the balloon 22 may be expanded tooccupy the entire volume of the stomach 10. The stomach 10 substantiallyconforms around the inflated balloon 22 so that substantially the entiresurface area of the balloon 22 is in contact with the wall of thestomach 10. The balloon is preferably sized to correspond generally tothe approximate size and shape of a slightly distended stomach uponexpansion of the balloon.

The heat exchange fluid 34 is introduced into the balloon 22 through anopening 33 formed in the distal end of the catheter shaft 24. Theintroduction of the heat exchange fluid 34 expands the balloon 22 tofill the volume of the stomach 10. The heat exchange fluid 34 circulateswithin the balloon 22 (as denoted by the arrows), and flows out of theballoon 22, back through the catheter shaft 24, and is then returned tothe heat exchange unit. The details of this closed-loop circulation ofthe heat exchange fluid will be discussed in more detail later. Becausethe heat exchange fluid is circulated in a closed-loop, the heatexchange fluid does not come into contact with either the stomach or thebloodstream, so the heat exchange fluid need not be a physiologic fluidsuch as saline. The heat exchange fluid 34 may be a gas or a liquid.However, in the event of a rupture of the balloon some of the heatexchange fluid would enter the digestive tract, so the heat exchangefluid should be non-toxic. Since physiological saline is a generallyacceptable heat exchange fluid in the preferred temperature ranges, itis a generally acceptable heat exchange fluid in the embodimentdescribed here. The heat exchange fluid 34 is circulated within theballoon 22, preferably for an extended period of time (ranging fromseveral hours to several days), in order to exchange heat between thecirculating heat exchange fluid 34 and the blood circulating through thevessels surrounding the wall of the stomach 10 in order to control thebody temperature of the patient. The balloon 22, inflated with thecirculating heat exchange fluid 34, acts as a heat exchange region. Thetemperature of the circulated heat exchange fluid 34 may besignificantly higher (for heating) or significantly lower (for cooling)than the normal body temperature. The heat exchange fluid 34 may bemaintained at a constant predetermined temperature such as zero degreescentigrade, or colder, for an extended period of time. It is alsocontemplated that a patient's temperature may be reduced by thisrelatively non-invasive technique over a short period of time in, forexample, an ambulance or an emergency room, and, subsequently, moreinvasive temperature control may be instituted in, for example, ahospital or cath lab.

Where the heat exchange fluid circulated through the balloon 22 iscolder than the core body temperature, and, in particular, blood in thevessels surrounding the stomach, heat will be exchanged between theblood and the heat exchange fluid through the wall of the balloon 22 andthe wall of the stomach, such that heat is absorbed from the blood. Ifthe temperature difference between the blood and the heat exchange fluid(sometimes called “ΔT”) is large enough (for example, if the blood ofthe patient is about 37° C., and the temperature of the heat exchangefluid is about 0° C.), enough heat may be exchanged to cool thetemperature of the blood sufficiently for therapeutic purposes. Heatwill also be exchanged with the core by conduction, and since the bodycore is liquid, largely water, heat is conducted fairly efficiently outof the core and into the heat exchange fluid. If the balloon catheter isleft in place long enough with the cold circulating heat exchange fluid,the entire body temperature of the patient may be cooled sufficiently toreduce the metabolism of the body and reduce the demands placed on theheart.

The diameter of the catheter shaft 24 is smaller than the diameter ofthe esophagus 12. The catheter shaft 24 is sized to provide sufficientclearance within the esophagus 12 so as to not block saliva drainage inthe esophagus 12 while the heat exchange fluid 34 is being circulatedwithin the balloon catheter 20. While there may be a need to deal withthe gag response during the insertion of the balloon catheter, whetherby sedation or otherwise, this generally will not be a problem after theballoon catheter is in place. Insertion of the balloon catheter may befacilitated by allowing the patient to drink some liquid during theinsertion. Once the deflated balloon is “swallowed,” the catheter shaftis in place and has a sufficiently small diameter so as not to block theesophagus. The natural swallowing motion of the throat will serve toinsure that the balloon portion is fully located in the stomach.

The distal portion of one embodiment of the balloon catheter 20 isillustrated in FIG. 3. The balloon catheter 20 is shown as having acoaxial lumen configuration in FIGS. 3 and 4, but it is to be understoodthat a side-by-side or dual lumen configuration may also be employed.The catheter shaft 24 having a coaxial lumen configuration includes aninflow lumen 36 and an outflow lumen 38. At the proximal end of thecatheter 20, the inflow lumen 36 is in fluid communication with theinlet 26 leading from the heat exchange unit 30, and the outflow lumen38 is in fluid communication with the outlet 28 leading to the heatexchange unit 30. The heat exchange fluid 34 flows into the balloon 22through the distal opening 33 of the inflow lumen 36 in the cathetershaft 24 to inflate the balloon 22. The heat exchange unit preferablyintroduces the heat exchange fluid 34 at a sufficient pressure tomaintain the inflated balloon 22 at the approximate size of the stomach10 while allowing the heat exchange fluid to 34 circulate out of theballoon 22 through the outflow lumen 38 and outlet 28, and back to theheat exchange unit 30.

The catheter shaft 24 is preferably constructed from a biocompatible,flexible material having suitable column strength such as PEBAX.Polyether block amides, sometimes referred to as PEBAX, are a family ofthermoplastic polyether-based polyamides often used for catheters withvarious multi-lumen profiles. The processing of such materials for thefabrication of such catheters is well known in the art.

The balloon 22 is attached to the catheter shaft 24 by a balloonattachment 23 which is well known in the art. The balloon attachment 23may be radiopaque, or visible to ultrasound, to act as a marker andallow an operator to determine when the balloon is fully positionedwithin the stomach 10. In the alternative, a marker separate from theballoon attachment 23 may be used. A temperature sensor 40 may also belocated in the area of the balloon attachment 23.

The material for the balloon 22 preferably is a thin-walled, highstrength, thermoplastic material, readily inflatable under fluidpressure and readily collapsible under vacuum. In this embodiment, theballoon 22 is made from polyethylene terephthalate (PET). The balloon 22should be dimensioned to conform generally with the stomach 10. Uponexpansion, the balloon 22 should approximate the size and shape of theslightly distended stomach 10. The balloon 22 is expanded by theintroduction of the heat exchange fluid 34. The act of slightlydistending the stomach may trigger increased blood flow through thestomach lining and enhance the heat exchange. Upon completion of theheat exchange procedure, the balloon 22 may be collapsed by applying avacuum to evacuate the heat exchange fluid 34 from the balloon 22.

Where the balloon 22 is composed of a substantially inelastic material,the inflow lumen 38 preferably extends substantially into the interiorof the balloon 22. The balloon 22, when deflated, may be wrapped aroundthe distal portion of the inflow lumen 38, and may be held in place by asheath (not shown), to create a low delivery profile for the ballooncatheter 20.

In an alternate embodiment, as illustrated in FIG. 5, the ballooncatheter 120 may include an elastic balloon 122 made from an elasticmaterial such as latex or polyurethane. The elastic balloon 122 may befastened to the catheter shaft 124 by an attachment 123 known in theart. The balloon attachment 123 may be radiopaque, or opaque toultrasound, to act as a marker and allow an operator to determine whenthe balloon is fully positioned within the stomach of the patient. Inthe alternative, a marker separate from the balloon attachment 123 maybe used. A temperature sensor 40 may also be located in or near the areaof the balloon attachment 23.

Although FIGS. 5 and 6 show the shaft 124 of the balloon catheter 120 ashaving a side-by-side (or dual) lumen configuration, it is to beunderstood that a coaxial lumen configuration may also be employed. Thecatheter shaft 124 having a side-by-side lumen configuration includes aninflow lumen 126 and an outflow lumen 128. The catheter shaft 124 ispreferably constructed from PEBAX or another suitable material. At theproximal end of the catheter 120, the inflow lumen 126 and the outflowlumen 128 are in separate fluid communication with the heat exchangeunit. The heat exchange fluid 134 flows into the balloon 122 through theinflow lumen 126 to inflate the balloon 122. Because the balloon 122 inthis embodiment is elastic, the lumen of the catheter shaft 124 need notextend substantially into the interior of the balloon 122, and a sheathmay not be needed to maintain a low profile for the balloon portion ofthe catheter 120. The heat exchange unit preferably introduces the heatexchange fluid 134 at a sufficient pressure to maintain the inflatedballoon 122 at the approximate size of the stomach while allowing theheat exchange fluid 134 to circulate out of the balloon 122 through theoutflow lumen 128 and back to the heat exchange unit. Upon completion ofthe heat exchange procedure, the elasticity of the balloon may aid inthe evacuation of the heat exchange fluid and the collapsing of theballoon.

One embodiment of the system for controlling the heat exchange by theballoon catheter is illustrated in FIG. 7. The temperature of the heatexchange fluid circulated within the balloon catheter 20 is controlledby the heat exchange unit 30. In this embodiment, the heat exchange unit30 includes a disposable heat exchanger cassette 50 and a control unit60 for controlling the temperature of the heat exchanger cassette 50.The control unit 60 receives a signal transmitted from a temperaturesensor such as a temperature probe inserted in the patient's vasculatureto provide an accurate measure of the core temperature of the patient.Other suitable temperature sensors may include bladder temperatureprobes, tympanic temperature probes, rectal temperature probes, orproperly situated skin temperature sensors.

The disposable heat exchanger cassette 50 includes a saline bag 52connected to the outlet 28 of a multi-lumen fluid conduit extending fromthe heat exchange element 50, a heat exchange plate 54, a pump head 56,and a fluid pathway 58. As previously discussed, the heat exchangeregion is the balloon 22 inflated by the closed-loop flow of the heatexchange fluid. The handle 32 of the balloon catheter 20 includes aconnection for the inlet 26, and a connection for the outlet 28 from thefluid conduit 54. As previously discussed, the inlet 26 and the outlet28 are in fluid communication with the respective inflow and outflowlumina of the multi-lumen catheter shaft 24. The saline bag 52 operatesas an external fluid source, and may be placed in fluid communicationwith the outlet 28 at a T-junction of the fluid conduit. In thealternative, the external fluid source may be directly connected to theheat exchanger cassette 50. The pump head 56 pumps the heat exchangefluid from the saline bag 52 through a fluid pathway 58 in the heatexchange plate 54, and then through to the balloon catheter via theinlet 26.

The heat exchange unit 50 may be configured to fit through an elongateslot 62 in the control unit 60. Other configurations are possible,depending on the requirements of the system design. Once inserted, thepump head 56 is placed in proximity to and couples with the pump driver64, generally either with a mechanical engagement or a magneticcoupling, and the heat exchange plate 54 is placed in proximity to andin thermal communication with a heat exchanger 66. In one embodiment,the heat exchanger 66 is a solid-state thermoelectric heater/coolerdevice capable of either generating heat or removing heat by changingthe polarity of the current activating the unit. The heat exchanger 66may be controlled so as to supply or remove heat from the system withoutthe need for two separate units. In the alternative, a cardiopulmonarybypass heat exchanger immersed in an ice-and-water slurry may beutilized.

The pump driver 64 engages and activates the pump head 56 to circulatethe heat exchange fluid through the serpentine fluid pathway 58 in theheat exchange plate 54. The heat exchanger 66 may act to heat or coolthe heat exchange fluid circulated through the serpentine fluid pathway58, and thereafter through the inlet 26 and inflow lumen of the ballooncatheter 20. The heat exchanger 66 regulates the blood temperature ofthe patient as desired by circulating the heat exchange fluid throughthe balloon 22 at the heat exchange region in order to add or removeheat from the body of the patient.

The pump driver 64 and heat exchanger 66 are responsive to thecontroller processor 68. The processor 68 receives data input fromsensors such as body temperature sensors 70 positioned to sense thetemperature at various locations of the patient. For example, thetemperature may be sensed at the patient's ear, heart region, bladder,rectum, esophagus, upper thigh or another appropriate location asdesired by the operator. The processor 68 may also receive data from atemperature sensor 40 provided on or adjacent to the balloon portion 22of the balloon catheter 20 to monitor the temperature of the heatexchange region in the stomach of the patient. Operating parameters ofthe control system, such as the desired body temperature of the patientor the desired temperature of the heat exchange fluid, may also bemanually input by the operator.

The controller processor 68 coordinates the various data received andselectively actuates the several operational subsystems to achieve andmaintain a desired body temperature for the patient. For example, theprocessor 68 may actuate the heat exchanger 66 to increase the amount ofheat being removed from the heat exchange fluid if the actualtemperature is above the specified temperature, or the processor 68 maydecrease the amount of heat being removed if the temperature is belowthe specified temperature. In the alternative, the processor 68 maycontrol the speed of the pumping of the heat exchange fluid.

In operating the heat exchange unit 30, the disposable heat exchangercassette 50 is inserted into the control unit 60, and the external fluidsource 52 is attached to the appropriate port of the heat exchangercassette 50, and the pump 56 is automatically or passively primed.Chilled or warmed biocompatible fluid such as saline, may be pumped intothe closed circuit balloon catheter, which exchanges heat directly withthe blood flowing around the stomach of the patient. The control unit 60serves to automatically control the patient's temperature. Oncetreatment with the balloon catheter 20 is complete, the balloon catheter20 is deflated and then removed from the patient, and the heat exchangercassette 50 is removed from the reusable control unit 60. Both theballoon catheter 20 and heat exchanger cassette 50 may then bediscarded. The control unit does not come into direct contact with theheat exchange fluid, and may be used immediately thereafter fortreatment on other patients with a new disposable heat exchangercassette and balloon catheter.

Other examples of systems for the automated control of a patient's bodytemperature are described in U.S. Pat. No. 6,149,676; and co-pendingU.S. patent application Ser. Nos. 09/138,830, 09/563,946 and 09/707,257,the entireties of which are expressly incorporated herein by reference.In addition, the heat exchange fluid may be cooled by passing the fluidthrough a cardiopulmonary bypass heat exchanger immersed in anice-and-water slurry.

If the patient is cooled below the shivering threshold (which varies foreach patient, but generally is at about 35.5° C.) some mechanism shouldbe used to combat shivering. Methods of combating shivering whilecooling a patient are described in detail in U.S. Pat. No. 6,231,594,which is hereby incorporated by reference in its entirety. For example,if a patient is cooled below his or her shivering threshold, which isthe temperature at which a patient, absent application of anti-shiveringmechanisms, would shiver, then a warming blanket might be applied, aloneor in conjunction with various anti-shivering drugs. A typicaltherapeutic regime may include the steps of: administering an initialbolus dose of a first anti-thermoregulatory response agent to thepatient (e.g., an oral dose of a serotonin 5 HT1a receptor agonist suchas 60 mg of buspirone); administering a subsequent dose of a secondanti-thermoregulatory response agent to the patient (e.g., an initialintravenous dose of an μ opioid receptor agonist such as 50 mgmeperidine administered by slow push followed by a similar second dose);and administering a further dose of the second anti-thermoregulatoryresponse agent by constant IV administration (e.g., about 25 mg/hour ofmeperidine). Another anti-shivering drug that may be useful isdexmedetomidine. A warming blanket may be wrapped around the patientwhen the first anti-thermoregulatory response agent is administered.Application of warmth to the patient's face may also be effective. Oncethe anti-thermoregulatory response mechanism is operating, cooling thepatient to a temperature below the shivering threshold may beaccomplished.

A patient with mild cardiac insufficiency may benefit from a period ofhypothermia. For example, the method of treatment may begin with theapplication of anti-shivering mechanisms, such as the application ofanti-shivering drugs and the application of a warming blanket. Thewarming blanket may not be turned on or may be turned on low at theoutset, and the power of the blanket increased as the temperature of thepatient is lowered. The balloon catheter is then introduced into thestomach and inflated with the heat exchange fluid to begin cooling thepatient to a desired temperature such as 32° C. Depending on thecondition of the patient and the therapeutic response, the temperaturemay be significantly higher, for example 35° C., but will usually not gobelow 30° C. since the heart begins to be sensitive and irritable belowthat temperature. The temperature of the patient is cooled at thedesired level for a length of time sufficient to provide a therapeuticbenefit. For example, the patient's temperature may be controlled bymaintaining the desired temperature of 32° C. within 0.2° C. for severalhours, usually more than four hours and sometimes more than one day.During this time the condition of the patient would be monitored, bothto identify and respond to any problem, for example to increase thepatient's temperature if he or she begins to exhibit symptoms that willbe relieved by increases in body temperature, and to follow thepatient's response to treatment to keep the length of cooling as shortand mild as possible to minimize the use of anti-shivering drugs.

Patients may be given hypothermic heart “holidays” for periods of 3hours, 12 hours, or even up to three days or longer, depending on thecondition and needs of an individual patient. When the patient is placedin a hypothermic condition, such as 1° C. or more below normothermic,and the output of the heart increases, the overall condition of thepatient can improve significantly. The heart may receive sufficientadditional blood and have a temporarily decreased metabolic need anddecreased metabolic waste products in order to recover to a healthierstate.

The patient is then slowly re-warmed to normothermia (usually 37° C.)using controlled re-warming. For example, re-warming at the rate of 0.2°C. may avoid injury that might occur with too rapid re-warming.Depending on the condition of the patient and the disease beingaddressed, re-warming at some other rate, for example, 0.4° C. per hour,half a degree an hour, or even a degree or more, might be appropriate.The re-warming may be active (i.e., the balloon temperature is greaterthan the core body temperature so that the system is actively addingheat to the patient's body) or may actually be slow cooling, that iswhere the balloon temperature is only slightly below the core bodytemperature so that the system is removing heat from the body but at arate that is slower than the body is generating heat, resulting in aslow increase in core body temperature.

A patient may also be maintained at hypothermia during a surgicalprocedure since the hypothermia is both inotropic and tissue protective.After the surgery, the patient may be maintained at the hypothermiclevel for an extended period of time, for example three hours, and thenslowly and controllably warmed back to normothermia, for example at 0.5°C. per hour.

While the present invention has been described with reference to thespecific embodiments thereof, it should be understood by those skilledin the art that various changes may be made and equivalents may besubstituted without departing from the scope of the invention. Inaddition, many modifications may be made to adapt a particularsituation, material, composition of matter, process, process step orsteps, while remaining within the scope of the present invention.Additionally, reference to the terms such as “device,” “apparatus,” andterms of similar import in the claims which follow shall not beinterpreted to invoke the provisions of 35 U.S.C. § 112, paragraph 6,unless reference is expressly made to the term “means” followed by anintended function.

What is claimed:
 1. An esophageal heat exchange device comprising: a heat transfer shaft insertable into an esophagus of a patient, the heat transfer shaft having a distal end configured to be positioned in a stomach of the patient during heat exchange therapy, the heat transfer shaft also having a first fluid lumen having a proximal end and a distal end and a second fluid lumen having a proximal end and a distal end, the first and second fluid lumens having a side by side configuration; an input port for introducing a heat exchange medium into the proximal end of the first fluid lumen; an output port for removing the heat exchange medium from the proximal end of the second fluid lumen; and a non-inflatable cavity disposed at the distal end of the heat transfer shaft, the cavity in fluid communication with the first and second fluid lumens such that the heat exchange medium flows from the first fluid lumen to the second fluid lumen through the cavity.
 2. The esophageal heat exchange device of claim 1, further comprising a pump in fluid communication with the first fluid lumens, the pump configured to pump heat exchange medium through the first fluid lumen, into the non-inflatable cavity, and out of the second fluid lumen.
 3. The esophageal heat exchange device of claim 2, further comprising a master control unit housing a heater or cooler for adding or removing heat to/from the heat transfer shaft; and wherein heat is exchanged between the esophagus and the heat exchange medium circulating in the heat transfer shaft so as to controllably alter the temperature of at least a portion of the patient.
 4. The esophageal heat exchange device of claim 3, further comprising a temperature sensor in communication with the master control unit.
 5. The esophageal heat exchange device of claim 4, wherein the master control controls the temperature of the heat exchange fluid flowing to the first fluid lumen based on signals received from the temperature sensor.
 6. The esophageal heat exchange device of claim 1, wherein the heat exchange shaft is formed of a flexible material.
 7. The esophageal heat exchange device of claim 1, wherein the heat exchange shaft is formed of a radiopaque material.
 8. The esophageal heat exchange device of claim 1, wherein the heat exchange shaft is formed from a material visible to ultrasound.
 9. The esophageal heat exchange device of claim 1, wherein the cavity is formed from an inelastic material.
 10. A heat exchange apparatus for removing heat from, or adding heat to, an esophagus of a patient, comprising: a heat transfer shaft insertable into an esophagus of a patient, the heat transfer shaft including a first fluid lumen having a proximal end and a distal end and a second fluid lumen having a proximal end and a distal end, the first fluid lumen and the second fluid lumen having a side by side configuration, and a non-inflatable cavity disposed at a distal end of the heat transfer shaft, the cavity in fluid communication with the first and second fluid lumens such that a heat exchange fluid introduced into the proximal end of the first fluid lumen flows from the first fluid lumen through the cavity into the distal end of the second fluid lumen, a pump in fluid communication with the first fluid lumen and the second fluid lumen, the pump configured to pump heat exchange fluid through the first fluid lumen and the second fluid lumen; a master control unit housing a heater or cooler unit; and wherein heat is exchanged between the esophagus and the heat exchange fluid circulating within the heat transfer shaft so as to controllably alter the temperature of at least a portion of the patient.
 11. The apparatus according to claim 10, further comprising a temperature sensor in communication with the master control unit.
 12. The apparatus according to claim 11, wherein the master control controls the temperature of the heat exchange fluid flowing to the first fluid lumen in response to signals received from the temperature sensor.
 13. The apparatus according to claim 10, wherein the heat transfer shaft is formed of a radiopaque material.
 14. The apparatus according to claim 10, wherein the heat transfer shaft is formed from a material visible to ultrasound.
 15. The apparatus according to claim 10, wherein the heat transfer shaft is formed of a flexible material.
 16. The heat exchange apparatus of claim 10, wherein the cavity is formed from an inelastic material.
 17. The apparatus according to claim 10, wherein the heat transfer shaft is insertable into a stomach through the esophagus of the patient, the heat transfer shaft having a distal end configured to be positioned in the stomach of the patient during heat exchange therapy. 